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BACKGROUND: Delays in surgery start times can lead to poor patient outcomes and considerable increases in healthcare expenditures. This is especially true in developing countries that often face systemic inefficiencies, such as a shortage of operating rooms and trained surgical personnel. With substantial effects on patient outcomes, healthcare efficiency, and resource allocation, identifying delays in first-case elective surgery is a crucial area of research. METHODS: A multicenter observational study was conducted at three comprehensive and specialized hospitals in the Amhara region of Ethiopia from May 1 to October 30, 2023. The primary aim of the study was to determine the occurrence of late first-case start times, defined as a patient being in the operating room at or after the hospital's incision time of 2:30 a.m. The secondary aim was to discover potential root causes of delayed first-case start times. All patients scheduled for elective surgery as the first case on the operating list throughout the study period were included in the study. Every emergency, day case, after-hours case, and canceled case was excluded. RESULTS: A total of 530 surgical patients were included during the study window from May 1 to October 1, 2023. Of these, 41.5% were general surgeries, 20.4% were gynecology and obstetrics surgeries, and 13.2% were orthopedic surgery procedures. Before the procedure started, nine (1.7%) of the participants had prolonged discussion with a member of the surgical team. Patients who arrived in the operating room waiting area at or after 2:30 a.m. were 2.5 times more likely to experience a first-case start time delay than those who arrived before or at 2:00 a.m. (AOR = 2.50; 95% CI: 1.13-5.14). Furthermore, participants with abnormal investigation results were 2.4 times more likely to have a late first-case start time (AOR = 2.41; 95% CI: 1.06, 5.50). Moreover, the odds of a late first-case start time were increased by 10.53 times with the surgeon being in the operating room at or after 2:30 a.m. (AOR = 10.53; 95% CI: 5.51, 20.11). CONCLUSION: The research highlights a significant occurrence of delayed start times for the first elective surgical procedures. Therefore, directing attention to aspects such as ensuring patients and surgical teams arrive promptly (by or before 2:00 a.m.) and timely evaluation and communication of investigative findings before the scheduled surgery day could facilitate efforts to maximize operating room efficiency and enhance patient health outcomes.
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INTRODUCTION AND IMPORTANCE: Caudal block is considered to be safe and provide optimal analgesia for pediatric patients undergoing sub-umbilical operations. It overcomes opioid-related side effects, particularly the dangers associated with respiratory depression in small children. CASE PRESENTATION: A 5-year-old male underwent uneventful hypospadias surgery under general endotracheal anesthesia. Caudal block planned to be administered postoperatively for postoperative analgesia then performed after palpation of sacral cornu with 8 ml of 0.25% bupivacaine. A few minutes later, the patient became apneic, heart rate, blood pressure, and oxygen saturation dropped abruptly-immediate resuscitation with ventilatory support, fluid bolus, and atropine administration. After a minute patients' vital signs returned to the normal range then 2 h later patient started to breathe spontaneously and consciousness is regained. After close follow-up for 24 h in the post-anesthesia care unit patient was discharged to the pediatric ward then discharged to home without any neurologic sequelae after 3 days. CLINICAL DISCUSSION: Total spinal anesthesia in a very infrequent incident during central neuraxial blocks, especially in the pediatrics population where a caudal block is usually performed. Manifestation of this event can be detected by loss of consciousness, cessation of respiratory effort, hemodynamic instability, and dilated pupils. Delayed treatment can result in cardiopulmonary arrest. CONCLUSION: Unanticipated total spinal anesthesia following central neuraxial blocks can potentially cause severe adverse consequences. Preventive modalities must be employed to avoid this incident. Early recognition and instant management should be instituted to avoid dangerous complications following the total spinal blockade.
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BACKGROUND: The main objective of this study was to resolve fascia iliaca compartment block controversies by putting the currently available evidences applied for knee, femoral shaft, and hip bone injury or related to surgery. METHODS: The databases PubMed, Cochrane Review, and Google Scholar were searched without regard to language or publication type for fascia iliaca compartment block before December 2020. After eligibility sorting and duplicate removal, a total of 26,609 articles were identified, with 21 of them being included for review. DISCUSSION: In the emergency department, fascia iliaca compartment block (FICB) has now become the standard of practice. Various evidence suggested that 20-40 ml of local anesthetic was required for an effective block in adult patients. CONCLUSION: For the knee, femoral bone, and hip region surgery, the fascia iliaca compartment block (FICB) provided better anesthesia quality, reduced systemic morphine consumption, and had fewer complications than epidural anesthesia. Anesthetists and surgical department staff should promote the FICB's benefits by emphasizing its superiority in pain management.
